Black Flies

by Shannon Burke

Silver Teeth turned to the kid with the beret, who kept his head lowered.

  “I spit on the ground,” the kid murmured.

  “He looked at us and spit. Looked, spit. That’s disrespect. So, you know what? I like this spot so much I’m gonna come out here every day for the next two weeks, park, and eat doughnuts for the whole day, right in this spot. Maybe he’ll learn to respect me then. Unless you wanna take care of this right now.”

  Rutkovsky had been eating the whole time. He lowered his fork.

  “You makin’ work for us?” Rutkovsky said.

  “Don’t think of it as work,” Pastori said. “Think of it as entertainment.”

  Silver Teeth turned to the kid with the beret, paused a moment, and then he slapped him. A smacking sound went up and down the block. Two grade-school kids playing football in the park turned and watched. We were all quiet. The kid with the beret didn’t try to run away. He hardly flinched when he was hit. He just stood there with his hands held to his sides, gripping his loose jeans in two fists. Silver Teeth paused a moment, studying him, then slapped him again, hard enough so the kid’s head turned and his beret flew off. Silver Teeth slapped again with his whole hand. There was blood on the kid’s nose and mouth. Tears ran down his cheeks. Silver Teeth glanced back at Pastori, who stood with his arms crossed, skeptical, as if to say, That’s not even close to being enough. Silver Teeth turned back and punched the kid in the left eye. He punched again in the exact same spot. Then again, and the kid went down with a thud. He lay on the dusty concrete, groaning faintly. Silver Teeth looked back, exasperated, as if to say, That’s gotta be enough. Pastori stood with his arms crossed, waiting. Silver Teeth turned and kicked into the kid’s belly. Kicked into him again. Kicked at his head twice and the kid did not groan the second time because he was unconscious. Pastori stood with his arms crossed. Silver Teeth went to kick again, but Rutkovsky jumped up and held him back, pulling him away, almost throwing him to the ground. Pastori laughed and uncrossed his arms.

  “All right, all right. Lucky you.” Then, with a sort of annoyance, “Guess Rut’s feeling generous today.”

  I’d been sitting there watching the whole thing. Rutkovsky turned on Pastori, who smiled, but stepped back. For a moment I thought Rutkovsky would go at Pastori, but he didn’t, and Pastori saw he wouldn’t. In a cool, offhand way Pastori motioned to the kid on the ground.

  “Look’t that. Fucking knocked him out.You don’t even have to hurry, Rut. He ain’t goin nowhere. Finish your dinner.”

  I saw blood trickling from the kid’s nose and mouth and pooling in the dusty concrete divot between the slabs of sidewalk.

  Rutkovsky reached for his radio, and said, “We’re being flagged for a multi-trauma in Jackie Robinson Park. Put us on the job.”

  We brought the kid into the hospital, where they found he had a concussion and a few broken ribs. Afterward, as we restocked the ambulance, Rutkovsky spoke in an impatient, dismissive tone: “I know you’re some bleeding heart, Cross, probably think you’re going to write up a complaint. Forget it. That kid was no angel. And nothin’ you could’ve done. I been out here a long time. I can step up. You can’t. If you tried, they’d’ve made it worse cause you wanted to stop em ...”

  Rutkovsky went on like this, but I thought he seemed to be trying too hard to convince me that I couldn’t have done anything, trying to give me an excuse for not stepping up, and maybe, making an excuse to himself for me. The truth is, I think he was surprised I hadn’t tried to stop Pastori. I’d only been on the streets for three months at that point. I think he was surprised that he’d had to do it himself.

  “What happened to you today?” Clara asked that night on the telephone. She was studying for her finals. We lived a mile away from each other, but we hadn’t seen each other for two weeks.

  “Another exciting day of saving lives,” I said.

  I’d started taking on an ironic, callous tone when I talked of my work.

  “Oh, come on, Ollie. You used to talk about it all the time. About your hero Rutkovsky. Whatever you tell me has got to be more exciting than my A and P textbook.”

  “Well, we watched the cops beat on a skel today,” I said. “That’s exciting. They kicked the shit out of him. And then the skel became our patient.”

  Clara was silent for a moment. Then she said, “So, what’s your definition of a skel?” That sort of annoyed me. That she’d pick on the word I used.

  “A skel is someone who deserves it,” I said, and she said, “Congratulations, Paramedic Cross. Only three months and you’ve already become one of them.”

  “Paramedics intubate, do chest decompressions, needle crichothyrotomies. A medic is trained to do everything himself, and in the worst circumstances. A good medic feels confident in every aspect of treatment, and is always the on-scene medical authority. Medics come to expect that sort of control in every aspect of their life. There are not many paramedics who are not arrogant. It’s practically a requirement for the job.”

  The next day, in Rutkovsky’s apartment, the radios resting upright on the counter, Rutkovsky kept his back to me as I told him about my argument with Clara. He mixed ice coffees in two red plastic cups and then turned with the cups, handed me one, and said, “Did you tell her that we couldn’t do anything? That we’re not cops?”

  “Fuck that,” I said. “I told her the guy deserved it. I acted like I was glad it happened. I said the guy was a skel and the definition of a skel was someone who deserved it.” Rutkovsky laughed. He liked that response. “And what did she say?”

  “She said I was becoming one of them.”

  “One of what?”

  “I don’t know,” I said. “The guys at the station. The rabble. For her, for her friends in med school, a paramedic is like a ... a ...”

  “A skel,” he said.

  “Exactly,” I said.

  Rutkovsky was quiet, stirring his drink, thinking about this. After a moment, he said, “I ain’t much for giving advice, and you may be the most dorky, green medic we’ve ever had up here, but you’re a Harlem medic now. You know what that means?”

  “Not.”

  “It means don’t take any shit,” he said.

  Hatsuru was the other medic on tour three who had a college degree. He was not one of the boys. He wasn’t well liked. He didn’t hang out. But he’d been in the service for three years and was a competent medic and was tolerated and basically left alone by the other medics. That’s the way it was at the station. There was this initial hazing period, but once you made it past that you were pretty much left alone and accepted, regardless of who you were. Hatsuru knew I was hoping to go to medical school and a few times that spring he talked to me about the MCATs or pulled me aside and gave me advice about how to start an IV or the best dosage of Narcan for a narcotic overdose or about med school applications and the best places to apply. In late May I was working with Hatsuru when we had a job for a guy found sprawled out in the bathroom in the Riverside projects. The guy had a single entrance wound above his left eyebrow and red blood soaking his white shirt. There were tiny fragments of shattered bone stuck to the curved surface of the tub behind his head. As we walked in we could hear the guy’s girlfriend in the hallway, letting out short, hard shrieks, as if she were being tortured. Hatsuru and I stood over this dead guy, just looking for a minute. Then Hatsuru felt his neck, put the bell of the stethoscope inside a rubber glove so it wouldn’t touch blood, listened for heart sounds, then he gripped the guy by the hair, lifted his head, saw the exit wound at the back—a hole the size of a tennis ball—and jerking his head up even higher, said, “Look at this, Cross. Come here. Look. Just like in lab. The meninges, the two lobes, and look at that. Right there. You can see it perfectly. The cerebellum!”

  Ten minutes later we stood outside the apartment writing up the DOA paperwork, and Hatsuru said, “I see what’s going on with you, Cross. You’re new here. You want to fit in. Don’t worry about it. Rutkovsky, LaFontaine, even Verdis ... They’v
e all been out here too long. They’re all fucked up in some way. You don’t want to fit in with them. When I’m on a job, I think of things medically. The rest of the time I close my eyes. I block it out. Because this stuff out here will fuck you up. It will make it so you can never be a doctor. Ignore it. Talk to the ER docs. Immerse yourself in the culture inside the hospital.” He held his textbook up. “This is what’s important. Rutkovsky. LaFontaine. Verdis. They’re distraction.”

  You didn’t come quick enough fuck you. I lost my welfare and I’m hungry fuck you. My son’s in jail for nothing fuck you. Cops broke our door down fuck you. Mom lost her Medicaid and now she’s dead fuck you. Fuck 911! Fuck the ambulance!

  That’s what we heard all day, every day—on the street, walking into buildings, even from the patients. And Hatsuru was right. Living under that sort of assault affected us all. There was a veneer of medical knowledge in all the medics, but we did not act like other medical professionals. We were some combination of soldiers and first-aid responders.We were like field medics in a war. Harlem was just coming out of its worst wave of violence in a century. It had lost a third of its population since the mid-eighties. Landlords had walked away from over 50 percent of the buildings in Central Harlem so there were blocks and blocks of boarded-up, half-burnt shells. Crime, poverty, drugs, hopeless people just hanging on—that was Harlem of the early nineties. The general consensus was that years of marginalization and exclusionary economic policies had created the fucked-up situation in Harlem. Anyone who lived there day-to-day believed that. And we believed it, too. We were all Harlem enthusiasts. We liked the neighborhood. We felt we were a part of it. But as representatives of the government we were assumed to have an indifferent attitude to the neighborhood’s problems, and we took an endless amount of shit for it. All day, every day, it was Fuck 911, Fuck Dinkins, 911’s a joke. We were supposed to get a thick skin and ignore it. And for the most part we did ignore it. Most of us acted like we didn’t care at all.

  A tired nurse led Rutkovsky and me through the dusty hallway of a low-income nursing home on 125th Street. Broken stretchers in the corner, a gray-haired mop left lying on the floor, splattered blood on dusty tiles.... There was only one nurse for forty patients and as we walked through the dim hallway all the old, bedridden patients heard the footsteps and yelled out, “Nurse! Nurse! Come help me! Nurse!”

  Rutkovsky and I turned into a room with eight beds—all the patients elderly, restrained, contracted, so their arms and legs didn’t straighten out. They all had short-term memory loss and bedsores and none of them would ever walk again. One toothless, ancient, shrunken old woman went, “Dub dub dub dub dub dub dub.” Another had white froth around her mouth and smelled of urine. Rutkovsky and I slipped inside the curtain on the last bed and saw an unconscious woman, impossibly wrinkled and withered, her skin browned like beef jerky, a grating sound with each breath.

  “How old?” Rutkovsky asked without looking up.

  “A hundred and one,” the nurse said.

  “Does she have a DNR? A living will?”

  The nurse shook her head.

  “What’s her history?”

  “She’s a hundred and one,” the nurse said tiredly. “Take a guess on the history. Dementia. Arthritis. Heart disease. GI bleeds ... I’ll get her chart.”

  She walked out and Rutkovsky jerked the curtain shut. He didn’t even bother feeling her pulse. He just pulled a chair over and sat back along the wall. After a moment he leaned forward and put the pulse oximeter on the woman’s finger. Her O2 saturation was ninety. I started feeling for a place to set an IV and Rutkovsky waved me off.

  “Don’t bother. Look at her, Cross. A hundred and one. We can’t do anything.”

  After a moment Rutkovsky reached over and lowered the head of the bed. The woman had fluid in her lungs. That was the grating sound we heard: fluid crackling as air moved through. By lying her flat he made it so the fluid spread out over the entire lungs and she couldn’t breathe at all. Basically, lying flat, she was drowning. I saw the O2 saturation dip past ninety and hover in the mid eighties—a very low number. I looked at Rutkovsky. He looked back at me. He crossed his arms. He waited for me to do something. To yell at him or to raise the woman’s head. I didn’t. I guess I thought I wouldn’t have drowned her myself, but she was a hundred and one years old. She lived a miserable life in that nursing home. What did it matter if she died or not? I would have treated, but Rutkovsky was my senior partner. I wouldn’t go against him.

  A long moment passed, the two of us just sitting there, the woman drowning in front of us. Then we heard footsteps in the tile hallway. It was the nurse coming back. Rutkovsky uncrossed his arms. He swore faintly. He raised the head and was fitting an oxygen mask on the patient when the nurse appeared at the curtain.

  “I got the chart,” she said.

  It was two inches thick.

  “Yeah, yeah,” Rutkovsky said to her. Then to me, “You get one try on the line.”

  Rutkovsky stepped outside the curtain with the chart and stood at the end of the row of elderly, indigent, bedridden patients and closed his eyes a moment. Then he opened them slowly, turned to the first page on the chart, and started on the paperwork.

  “The health care professional is in a position of giving, of power, while the patient is always in a craving, submissive role. Given the one-sided nature of the relationship, given the endless procession of sickness, misery, and death, unless the health care professional has a truly philanthropical bent, he or she will become accustomed to the suffering, indifferent to it, and in the end, disdainful of it. A patient is like a file or a phone call or a client. A patient means work. The cultural norm is to treat sick people with compassion, but the norms in the outside world and the norms in the hospital are in opposition to each other. Indifference is common. Moments of offhand cruelty are common. If you’re not careful there’ll come a point where you’ll wish someone dead out of laziness.”

  “He was a skel,” LaFontaine said. “Not only do I not care. I’m glad he’s dead.”

  “I don’t believe you,” Hatsuru said.

  “I’m paid to treat, that’s all, not to care. Why pretend I do?”

  “Because you’re a good medic,” Hatsuru said matter-of factly “Despite yourself. And you can’t be good at this job without caring a little. You need some indifference to keep an objective distance. But you need to care a little, too.”

  LaFontaine gestured to Hatsuru’s textbook.

  “Keep on reading, smart guy. You got all the answers.”

  The medics on tour three were sitting around the lounge of the station—Hatsuru, LaFontaine, Rivett, Rutkovsky. It was a few days after that job in the nursing home, and LaFontaine was telling us about one of his patients that day, a perp who’d tried to stab a cop in the neck with a screwdriver and had gotten shot eight times. LaFontaine said he was glad the kid was dead.

  “Whatta you think?” Hatsuru gestured to Rivett. “Can you be a good medic without caring if your patients live?”

  “Most people care a little whether they admit it or not,” Rivett said. He looked pointedly at LaFontaine, but LaFontaine just waved a hand tiredly, and said, “And then there’s the people who really don’t give a fuck.”

  “It’s something to be proud of,” Rivett said. He motioned to me. “You got a mouth, Cross. Is it possible not to care at all and be a good medic?”

  I started to say it wasn’t, but LaFontaine burst out at the same time, “Don’t even ask that guy! He’s been on the street for five minutes. He wants to help drug-dealing, crack-addict murderers with HIV He’s like the Mother Teresa of Harlem!”

  Everyone sort of took this in, smiling—the Mother Teresa of Harlem.

  “First I’m The Coroner. Now I’m Mother Teresa. What’s next?”

  “Med school,” Rivett said, and a few people snickered.

  “So whatta you think, Rut?” LaFontaine asked. “Can you be a good medic and not care at all?”

 
Rutkovsky flicked his cigarette into the room and said, “Someone who really didn’t care wouldn’t talk about it so much.”

  Rutkovsky left the butt smoking near Hatsuru’s foot. A minute later Verdis hobbled in, got down on his bad knees, picked the butt from the floor, and tossed it in the trash.

  An arching stone stoop with the spackle-filled screw holes on top where the brass railing had been, a doorway propped open with a pizza box, and then a nice-looking lobby with a marble floor and the fixtures overhead for a missing chandelier. Grouped old ladies sat behind a foldout desk in the lobby, watching whoever went in and out of the building. As we walked in the crowd of jabbering, squawking community do-gooders were all waving and talking at once: “He just got a little thump ... He don’t want no doctor ... I told em not to call. I said it! He just walked away! He ain’t here!”

  I raised my radio to cancel the job, but Rutkovsky motioned for me to hold off and started for the stairway “He ain’t here. I told you,” one of the old ladies called out and Rutkovsky just nodded and kept going up the stairs, murmuring, “Gotta check the roof.”

  The two of us started up the dim, marble-topped stairs, past the first, the second, and the third floor. I had no idea where we were going. As Rutkovsky turned at the last landing, he said, “I lived here 1979. Nice view on top. Come on.”

  At the top of the stairs a bar across the door read: EMERGENCY EXIT. Rutkovsky pushed it and waited for an alarm, but nothing happened, and we burst out onto the tar-covered roof. The white noise of the city. Orange light. The sun just going down over the crisscrossed buildings of Amsterdam Avenue. To the west we could see the Hudson and the towers of the George Washington Bridge and the palisades of New Jersey. To the south the spires of City College. And to the east, down the slope of 141st Street, all of Central Harlem. Tar roofs and water towers and clothes lines. The pastel stucco fronts of St. Nicholas Avenue. Rutkovsky sat on the edge of the wall and pointed out objects with the antenna of his radio—a softened look to him for a moment.